Suicide and deliberate self-harm – a second opinion

Suicide is an intentional, self-inflicted, life-threatening act resulting in death from any of number of means. Deliberate self-harm (DSH) is an intentional, self-inflicted, non-fatal act commonly effected by physical means – drug overdose or poisoning.

Although distinct from each other as psychiatric emergencies, there are a number of overlapping features involved in both.

The size of the problem

In 2012 nearly 6,000 people in the UK age 15 and over took their own lives. Suicide accounts for about 1 per cent of all deaths.

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At any age, men are at least three times more likely to commit suicide than women. The highest suicide rate is among men aged 40 to 44, where about one in 4,000 take their own life.

Cases of DSH (also known as parasuicide) are more than 30 times more common than suicide, although they differ in that there is no direct intention of killing oneself.

However, for these people the suicide rate in the year following deliberate self-harm is 100 times greater than for the general population. So DSH should be taken as a warning sign that someone is a considerable risk of suicide.

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There are several hundred thousand cases of DSH each year and, unlike suicide, women predominate over men in a 2:1 ratio over all age groups with the highest rate seen in the 15 to 24 age group.

Who is at risk?

Being male, unemployed, retired, divorced, widowed or separated and living in isolation in a deprived urban area are all risk factors.

Relationship problems are top of the lists of issues contributing to suicide or DSH. But it's often a complex picture and unhappy life events, such as bereavement, relationship break-ups, work problems or financial disaster play a part, as do chronic disabling pain or illness, pre-existing psychiatric conditions such as depression, early dementia, alcohol or other drug abuse, anorexia nervosa and schizophrenia.

A family history of self-harm is not uncommon either.

Assessment of risk

Assessment aims to establish the degree of any suicidal intent now or in the future, and to intervene in any medical disorder or personal or social problem leading to DSH.

Many people who self-harm have spoken to their relatives, friends or doctors in the weeks running-up to the actual act of DSH. Therefore, it is likely that a proportion of self-harming acts are potentially preventable with the right help.

Although people are often scared to ask, enquiring about suicidal feelings is important – it helps sufferers believe that their hopeless plight is appreciated and sympathetically understood. Asking about suicidal feelings does not precipitate someone into carrying out the act.

Ask about the frequency and intensity of any suicidal thoughts and whether any active plans to end life are being considered currently. Feelings of worthlessness and despair are a worrying sign more linked to suicide.

Depressed mood, weight loss, insomnia and delusions are also very serious risk factors. A doctor should always be approached for advice and to assess such symptoms.

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In DSH, intolerable stress is a major factor and an impulsive, immature or aggressive personality makes self-harming acts more likely. Alcohol is also frequently involved. Motives may be a cry for help, to escape from an awful situation or to manipulate or punish other people.

The most common methods of suicide in the UK in 2012 were hanging, strangulation and suffocation (58 per cent of male suicides and 36 per cent of female suicides) and poisoning, usually by a drug overdose (43 per cent of female suicides and 20 per cent of male suicides).

In DSH or parasuicide, the majority of cases involve a drug overdose although some choose self-mutilation, mainly of wrists and forearms, but occasionally other parts of the body.

Suicidal intent

This is indicated by evidence of premeditation (such as saving up tablets), taking care to avoid discovery, failing to alert potential helpers, carrying out final acts (such as writing a will) and choosing a violent or aggressive means of DSH allowing little chance of survival.

Prevention and treatment

People at risk of suicide should be treated urgently in hospital to recognise and manage underlying problems. Antidepressants or, in certain cases, even electroconvulsive therapy (ECT) together with constant psychiatric nursing supervision may be required.

Social intervention, follow-up and counselling can be extremely effective.

Most people who self-harm improve when their coping skills improve and when personal and social problems are properly resolved. So on-going counselling is also important.

The Samaritans

The Samaritans provides a 24-hour nationwide telephone service (08457 90 90 90) manned by trained volunteers offering support and advice to people at times of crisis.

Your own GP can provide someone on constant call alert also.

If you are worried about yourself, a friend or relative, don't delay in seeking professional help. It could save a life.

The materials in this web site are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. The web site does not have answers to all problems. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor - for further information see our Terms and conditions.

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